Category Archives: Addiction

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In Do the Right Thing, Dan Ariely, author of Predictably Irrational, highlights new research that “our decisions kill us.” He draws on the work of Ralph Keeney, whose paper (pdf) Personal Decisions Are the Leading Cause of Death, uses US data to show that “44.5 per cent of all premature deaths in the US result from personal decisions — choices such as smoking, not exercising, criminality, drug and alcohol use and unsafe sexual behaviour.”

This phenomenon is not limited to developed/industrial countries. Nicholas Kristof writes:

If the poorest families spent as much money educating their children as they do on wine, cigarettes and prostitutes, their children’s prospects would be transformed. Much suffering is caused not only by low incomes, but also by shortsighted private spending decisions by heads of households.

And it’s not just premature deaths and worse education, these types of behaviors cost a lot. Just take the May headline, Governments’ Drug-Abuse Costs Hit $468 Billion, Study Says. Most of those costs were in health or law enforcement, with just 2 percent spent on prevention, treatment, and research.

This is where we need really innovative approaches to understanding consumption, human decision making, and how we regulate our behavior. Behavioral economics is not all that; we do WEIRD research, instead of MYOPICS studies; we say poverty poisons the brain, but forget about just how poverty comes to be; we blame bad behavior on bad hormones, rather than doing more substantive work to understand people’s behavior.

These problems are not all caused by biological mechanisms or social construction, they are not all rooted in human psychology or deviations from rationality. They are human phenomena, requiring that we integrate ideas across multiple domains. To do that, anthropology needs psychology and neuroscience, just as they need anthropology. The impact of what we DO is enormous. And I’m betting that understanding what we do better will help us become more human – to find ways to deal with our own decisions and flaws, not just through technical fixes or imposed solutions, but also through finding ways to better promote our potential.

Of the 23 million people who struggle with alcohol or drug abuse on a yearly basis, roughly 1.2 million regularly attend Alcoholics Anonymous (AA) meetings as a way to stop drinking. AA was the first 12-step program to be created. Founded on December 14, 1934 by Bill Wilson and Robert or “Dr. Bob” Smith, AA combines self-assessment, reconciliation, group therapy, and surrendering control to a “higher power” in a progressive plan consisting of 12 distinct steps to combat impulsive cravings to use.

“Secret of AA: After 75 Years, We Don’t Know How It Works”, written by Brendan Koerner for Wired, does a thorough job explaining the history and approach of Alcoholics Anonymous in the United States. Koerner writes that, “There’s no doubt that when AA works, it can be transformative. But what aspect of the program deserves most of the credit?… Stunningly, even the most highly regarded AA experts have no idea.”

Koerner then examines how research in the behavioral sciences and neurology can provide insights to AA’s intermittent success. Here we learn that it’s not just the twelve steps but also the power of the group, from the commitment the individual feels to forming close relationships that can provide a sense of security to the opportunity to relearn how to connect to others without alcohol. Koerner also argues that the experience of public confession, both doing it and seeing it, helps individuals strengthen the regulatory powers of their prefrontal cortex, weakened after years of drinking.

However, in trying to account for the modest but significant beneficial effects AA can have for many individuals, Koerner leaves out important “soft sciences”, such as anthropology. Why do people attend AA? It’s not just to strengthen their prefrontal cortices.

In this post I will outline some societal forces that have led to AA’s popularity. I will also argue that the social sciences are integral for crafting new and effective addiction treatments. The ideas and data presented here come in large part from my comparative research on alcohol use and abuse among homeless men, college students, and veterans struggling with post-traumatic stress disorder.

Societal Forces at Play in Biomedicine

AA has been the subject of countless studies, yet reported success rates vary enormously: between 5 and 75 percent. This may be due to AA’s shunning of individual identification and the ease with which members enter and leave the program. However, several studies indicate that AA does not work for everyone and that, for most people, does not work at all.

While scientific support for AA or other 12-step programs is inconclusive, most medical practitioners strongly recommend it as a primary means to treat addiction. In Wired, addiction-medicine specialist Drew Pinsky states: “In my 20 years of treating addicts, I’ve never seen anything that comes close to the 12-steps. In my world, if someone says they don’t want to do the 12-steps, I know they aren’t going to get better.”

This contradiction between the little if any definitive scientific proof that AA reliably treats those suffering from addiction and the wide-spread endorsement of AA by medical and governmental officials raises an important sociological question:

So I’m now down in Tampa, getting set up at the University of South Florida after some good years at Notre Dame. Tampa looks great – an exciting city. And USF looks like it will definitely support interdisciplinary efforts like neuroanthropology. So it’s all good.

Here’s a quote that caught my eye on Sunday:

For in the anything-goes atmosphere of our recent past, it wasn’t just external controls that went awry; inwardly, people lost constraint and common sense, too. Now there is a case to be made that problems of self-regulation — of appetite, emotion, impulse and cupidity — may well be the defining social pathology of our time.

In the late 1970s, the historian Christopher Lasch famously described America as a culture of narcissism. Today we might well be called a nation of dysregulation. The signs that something is amiss in our inner mechanisms of control and restraint are everywhere.

Whybrow is the author of American Mania: When More Is Not Enough. It definitely looks like a neuroanthropology-friendly work, with the Amazon description reading: “The indictment of American society offered here—that America’s supercharged free-market capitalism shackles us to a treadmill of overwork and overconsumption, frays family and community ties and leaves us anxious, alienated and overweight—is familiar. What’s more idiosyncratic and compelling is the author’s grounding his treatise in political economy (citing everyone from Adam Smith to Thorstein Veblen) as well as in neuropsychiatry, primatology and genetics.”

Building on Whybrow’s work, Warner writes near the end of her piece:

The larger structural problems that create our widespread envy, greed, overconsumption and debt — gross income inequality, for starters — will be much more difficult, politically, to address… [T]he pressures that drive the dysregulated American haven’t abated any since the fall of 2008. Wall Street is resurgent, and unemployment is still high. For too many people, the cycle of craving and debt that drives our treadmill existence simply can’t be broken.

It’s the “modern misfits” story, where human nature no longer matches the human culture we’ve created. That too is familiar. But at least there is an appreciation of causation at different levels, from human psychology to structural problems, and that’s good. And I do happen to think that issues surrounding consumption and self-regulation are rather important, and not sufficiently recognized as problems that need more than simple answers like a Drug War or a pill to break the cycle of craving…

This is the pregaming mentality expressed by a current undergrad at our mid-Western university. This mentality can be summarized: if you have to go to something, why not be buzzed when you do it?

Across the country, on any given weekend night, college students are often consuming four or five, sometimes even 10 drinks, before they even make it out of their dorm room for a night of partying, the dorm dance, or even the latest sports event.

They consume what many medical professionals construe as dangerous, sometimes lethal, amounts of alcohol in a short period of time. Then students often find themselves passing out, throwing up and even being taken to the hospital. And that’s before they even make it to the party.

From an outsider’s point of view, this may not sound like a lot of fun. For college students, pregaming is often the best part of the night. Our question as student researchers was, Why?

Our Research

Due to the recent emergence of pregaming, little is known about the mentality behind it. Working with the university group in charge of helping to prevent and treat alcohol abuse, we aimed to understand the social and cultural bases for high-risk drinking and pregaming. Previous student research on pregaming focused on gender differences, and can be found in the post “College Drinking: Battle of the Sexes?”

The statistics were already clear for the university office in charge of alcohol education and prevention – almost 80% of students who have gotten in trouble for alcohol-related events were pregaming on the night of the incident. Counselors there feared that the high-risk drinking habit of pregaming has become synonymous with students social lives.

Our project aimed at both understanding students’ general attitude towards pregaming as well as why students stop drinking on a given night. These questions could offer insight and clues to effective handling of the problem of pregaming by students and the university alike.

It was a very stimulating visit, and given their technology gurus there, I can share with you two key parts of it.

First there is the video of my lecture on Evolution, Behavior and the Encultured Brain. You don’t actually get to see me, however – you see my Powerpoint slides and hear my accompanying lecture. In the talk I cover a lot of my work on evolutionary theory and addiction, and then discuss how that work has lead me to neuroanthropology and how neuroanthropology works as a good complement to evolutionary biology.

I also took part in a podcast, where I got involved in a great discussion with students at Binghamton about my research on substance use and abuse in Colombia. So in the podcast I range more widely over my work, in particularly discussing some of the cultural anthropology work I have done. So you can also get the Daniel Lende podcast.

The new book by Phillippe Bourgois, Righteous Dopefiend, has just been published by University of California Press. Righteous Dopefiend covers Bourgois’ long-term ethnographic work with heroin injectors and crack smokers on the streets of San Francisco. Jeff Schonberg provided haunting photographs for the book.

“Calling this book ethnography would be like calling The Wire a cop show: what comes roaring out of its pages is almost as visceral and devastating as spending a night in ‘the hole’ itself.”
-Mike Davis, author of Planet of Slums

“Philippe Bourgois and Jeff Schonberg provide a riveting narrative of the daily struggles for survival of homeless people with a physical and emotional addiction to heroin. The authors’ poignant account of these experiences features sophisticated analytic themes that enable them insightfully to integrate discussions of agency and moral responsibility on the part of homeless addicts with an analysis of the powerful structural forces that shape the addicts’ lives. Righteous Dopefiend is a must-read.”
– William Julius Wilson, author of More than Just Race: Being Black and Poor in the Inner City

Here’s the UC Press description:

This powerful study immerses the reader in the world of homelessness and drug addiction in the contemporary United States. For over a decade Philippe Bourgois and Jeff Schonberg followed a social network of two dozen heroin injectors and crack smokers on the streets of San Francisco, accompanying them as they scrambled to generate income through burglary, panhandling, recycling, and day labor. Righteous Dopefiend interweaves stunning black-and-white photographs with vivid dialogue, detailed field notes, and critical theoretical analysis. Its gripping narrative develops a cast of characters around the themes of violence, race relations, sexuality, family trauma, embodied suffering, social inequality, and power relations. The result is a dispassionate chronicle of survival, loss, caring, and hope rooted in the addicts’ determination to hang on for one more day and one more “fix” through a “moral economy of sharing” that precariously balances mutual solidarity and interpersonal betrayal.

And here’s Publisher’s Weekly starred review:

In this gritty ethnography exploring the world of San Francisco’s homeless heroin addicts, Bourgois, anthropology and community medicine professor at the University of Pennsylvania, and Schonberg, a photographer and graduate student in medical anthropology, draw on a decade immersed in this subculture to eloquently elaborate on the survival techniques and intimate lives of black and white addicts who live in self-made communities and work the economic fringes for survival. The authors explore racial boundaries and crossings, love stories, family relations, parenting, histories of childhood abuse, as well as the constant work of navigating hostile police enforcement, exploitative and helpful business owners, overburdened medical services and social service bureaucracies.

The book details the gruesome material toll of addiction, infection and homelessness and the risks of ongoing personal and institutional violence. Bourgois and Schonberg create a deeply nuanced picture of a population that cannot escape social reprobation, but deserves social inclusion. Schonberg’s photographs capture the scars of addiction, the social bonds between romantic pairs and drug-running partners and the concerted efforts at domesticity without a domicile. The collage of case studies, field notes, personal narratives and photography is nothing short of enthralling.

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Neuroanthropology is a collaborative weblog created to encourage exchanges among anthropology, philosophy, social theory, and the brain sciences.
We especially hope to explore the implications of new findings in the neurosciences for our understanding of culture, human development, and behaviour.
If you would like more information, please contact Greg Downey at Macquarie University greg.downey (at) mq.edu.au (remove spaces).